Provider Demographics
NPI:1962909747
Name:RAY, ANGELA DORETHA (LCDC III)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DORETHA
Last Name:RAY
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 GILA DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-3007
Mailing Address - Country:US
Mailing Address - Phone:513-344-4986
Mailing Address - Fax:
Practice Address - Street 1:621 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4315
Practice Address - Country:US
Practice Address - Phone:513-795-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)